Central Iowa Community Services Mental Health and Disability Services FY 2017 Annual Service and Budget Plan

Central Iowa Community Services Mental Health and Disability Services FY 2017 Annual Service and Budget Plan Geographic Area: Serving the Counties of Boone, Franklin, Hamilton, Hardin, Jasper, Madison, Marshall, Poweshiek, Story, and Warren Counties. Approved by the CICS Governing Board March 24, 2016 Fiscal Year 2017 1

Table of Contents Introduction... 3 Access Points... 4 Targeted Case Management... 5 Crisis Services... 6 Basic Crisis Services... 6 Planning for FY 17... 6 Prevention, Education and Public Awareness... 6 Response... 7 Resolution... 7 Scope of Services and Projection of Need... 9 Expenditure Budget... 16 Revenues... 21 Financial Forecasting... 21 Provider Reimbursement Provisions... 21 Provider Network... 23 Fiscal Year 2017 2

Introduction Central Iowa Community Services (CICS) was formed under Iowa Code Chapter 28E to create a Mental Health and Disability Service Region in compliance with Iowa Code 331.390. In compliance with IAC 441-25 the CICS Management Plan includes three parts: Annual Service and Budget Plan, Annual Report and Policies and Procedures Manual. CICS Management Plan is available on CICS Website www.cicsmhds.org and the DHS Website http://dhs.iowa.gov. The Annual Service and Budget Plan has been approved by the CICS governing board and is subject to approval by the Director of the Department of Human Services. Planning for Fiscal Year 17 centers on expansion of access to services including augmenting service coordination efforts, building provider efficiencies through training and education, and developing additional services to meet the needs of the individual counties of CICS. CICS maintains local offices in each county to provide access to services. Boone County 900 W. 3 rd St. Boone, Iowa 50036 Phone: (515) 433-0593 Fax: (515) 432-2480 Office Hours: Monday Friday, 8:00am - 4:30pm Franklin County 123 1st Ave. SW Hampton, Iowa 50441 Phone: (641) 456-2128 Fax: (641) 456-2852 Office Hours: Monday Friday, 8:00am - 4:30pm Hamilton County 500 Fairmeadow Dr. Webster City, Iowa 50595 Phone: (515) 832-9550 Fax: (515) 832-9554 Office Hours: Monday Friday, 8:00am - 4:30pm Hardin County 1201 14th Ave. Eldora, Iowa 50627 Phone: (641) 939-8168 Fax: (641) 939-8247 Office Hours: Monday Friday, 8:00am - 4:30pm Jasper County 115 N. 2nd Ave. East Newton, Iowa 50208 Phone: (641) 791-2304 Fax: (641) 787-1302 Office Hours: Monday Friday, 8:00am - 4:30pm Madison County 209 E. Madison St. Winterset, Iowa 50273 Phone: (515) 462-2931 Fax: (515) 462-3076 Office Hours: Monday Friday, 8:00am - 4:30pm Marshall County 101 E. Main St. Marshalltown, Iowa 50158 Phone: (641) 754-6390 Fax: (641) 754-6391 Office Hours: Monday Friday, 8:00am - 4:30pm Poweshiek County 200 4 th Ave W. Grinnell, Iowa 50112 Phone: (641) 236-9199 Fax: (641) 236-1349 Office Hours: Monday Friday, 8:00am - 4:30pm Story County 126 S. Kellogg Ave. Suite 001 Ames, Iowa 50010 Phone: (515) 663-2930 Fax: (515) 663-2940 Office Hours: Monday Friday, 8:00am - 4:30pm Warren County 1007 S. Jefferson Way Indianola, Iowa 50125 Phone: (515) 961-1068 Fax: (515) 961-1142 Office Hours: Monday Friday, 8:00am - 4:30pm Fiscal Year 2017 3

Access Points An access point is a part of the CICS service system that is trained to complete the MH/DS regional applications and refer individuals for service eligibility. Access points are educated to respond to the individual s stated and assessed needs by providing linkage to appropriate programs. CICS will provide ongoing training on the referral and application process for all funding streams and comprehensive continuous integrated system of care. Primary Access Points Address Phone Number Boone County Community Services 900 W 3rd St, Boone IA 50036 515-433-0593 Franklin County Community Services 123 1st Ave SW, Hampton IA 50441 641-456-2128 Hamilton County Community Services 500 Fairmeadow Dr, Webster City IA 50595 515-832-9550 Hardin County Community Services 1201 14th Ave, Eldora IA 50627 641-939-8168 Jasper County Community Services 115 N 2nd Ave E, Newton IA 50208 641-791-2304 Madison County Community Services 209 E Madison St, Winterset IA 50273 515-462-2931 Marshall County Community Services 101 East Main, Marshalltown IA 50158 641-754-6390 Poweshiek County Community Services 200 4 th Ave W, Grinnell IA 50112 641-236-9199 Story County Community Services 126 S Kellogg Ave Suite 001, Ames IA 50010 515-663-2930 Warren County Community Services 1007 S Jefferson Way, Indianola IA 50125 515-961-1068 Access Points Address Phone Number Advanced Therapy Solutions/Optimae LifeServices 1730 1st Ave E, Newton IA 50208 641-787-9133 Berryhill Center for Mental Health 1610 Collins Street, Webster City IA 50595 515-832-6626 Capstone Behavioral Healthcare, Inc 306 N 3rd Ave E, Newton IA 50208 641-792-4012 Center Associates 9 N 4th Ave, Marshalltown IA 50158 641-752-1585 Central Iowa Residential Services Inc. 111 E Linn St, Marshalltown IA 50158 641-752-5762 Christian Opportunity Center 1602 N 14th St, Indianola IA 50125 515-961-3653 Crossroads Mental Health 1223 E Buchanan Street, Winterset IA 50273 515-462-3105 Eyerly Ball Community Mental Health Services 105 S Marshall, Boone IA 50036 515-298-0181 Eyerly Ball Community Mental Health Services 2521 University Blvd, Suite 121, Ames IA 50010 515-598-3300 Eyerly-Ball Mental Health 1301 Center St, Des Moines IA 50139 515-243-5181 Genesis Development 927 8th Street, Boone IA 50036 515-432-7288 Genesis Development 115 E Washington, Winterset IA 50273 515-462-9083 Genesis Development 1809 W 2nd Ave, Indianola IA 50125 515-961-6918 Hansen Family Hospital Behavioral Health Services 322 ½ College Ave, Iowa Falls IA 50156 641-648-6491 Hardin County FIA Friendship Club 602 South Oak St, PO Box 622, Iowa Falls IA 50156 641-648-7500 House of Mercy 200 N 8th Ave E, Newton IA 50208 641-792-0717 House of Mercy 310 North Buxton St, Indianola IA 50125 515-358-7610 Integrated Treatment Services 303 S 2 nd Ave W, Newton IA 50208 641-792-0045 Madison County Memorial Hospital 300 W Hutchings St, Winterset IA 50273 515-462-2373 Mary Greeley Medical Center 1111 Duff Ave, Ames IA 50010 Adult Behavioral Unit -515-239-2683 Emergency Room 515-239-2155 TLP - 515-239-6747 MIW, Inc. 909 S 14th Ave, Marshalltown IA 50158 641-752-3697 Midwest Counseling 821 5 th Ave, Grinnell IA 50112 319-668-1217 Orchard Place Guidance 808 5th Ave, Des Moines IA 50309 515-244-2267 Story County Medical Center 640 S 19th St, Nevada IA 50201 515-382-2111 Van Diest Medical Center 2350 Hospital Dr, Webster City IA 50595 515-832-9400 Fiscal Year 2017 4

Targeted Case Management CICS offers access to cost effective, evidence based, conflict free Targeted Case Management as described in IAC 441-25.21(1)g. Designated Case Management agencies serving CICS are accredited according to the rules of the Department of Human Services. Targeted Case Managers meet the qualifications as defined in IAC 441-24. Targeted Case Management meets the following expectations: Performance and outcome measures relating to the safety, work performance, and community residency of the individuals receiving the service. Standards including but not limited to social history, assessment, service planning, incident reporting, crisis planning, coordination, and monitoring for individuals receiving the services. Methodologies for complying with the requirements of sub rule 441-25.21 g, which may include the use of electronic record keeping and remote or internet based training. CICS has identified the following providers for case management to offer services to individuals enrolled in the program. Case Management is available in each local office in the CICS region. Case Management Entity County Community Services Targeted Case Management Address Phone number Boone County 900 W 3rd St, Boone IA 50036 515-433-0593 Madison County 209 E Madison St, Winterset IA 50273 515-462-2931 Story County Case Management 126 S Kellogg Ave Suite 001, Ames IA 50010 515-663-2930 Easter Seals 2920 30 th St, Des Moines IA 50322 515-663-2930 Community Support Advocates 6000 Aurora Ave Suite B, Des Moines IA 50322 515-883-1776 Child Serve 5406 Merle Hay Road, Johnston IA 50131 515-727-1476 DHS Case Management 400 S W 8 th St, Des Moines IA 50319 515-242-6877 Jasper office 641-787-0318 Marshall office 641-844-1510 The local offices of CICS also provide Service Coordination for individuals who do not qualify for case management. Fiscal Year 2017 5

Crisis Services Crisis Services include crisis prevention, response and resolution strategies. Annual Service and Budget Plan Basic Crisis Services Emergency services and basic crisis response are provided through the Community Mental Health Centers and providers listed below. Emergency Service Providers: Area Provider Location Phone Boone Eyerly Ball Community Mental Health Services 105 S Marshall, Boone, IA 50036 515-298-0181 Franklin Berryhill Center for Mental Health 1610 Collins Street, Webster City IA 50595 515-832-6626 Hamilton Berryhill Center for Mental Health 1610 Collins Street, Webster City IA 50595 515-832-6626 Hardin Center Associates 9 N 4th Ave, Marshalltown IA 50158 641-752-1585 Jasper Capstone Behavioral Healthcare, Inc 306 N 3 rd Ave E, Newton IA 50208 641-792-4012 Madison Crossroads Mental Health 1223 E Buchanan Street, Winterset IA 50273 515-462-3105 Marshall Center Associates 9 N. 4th Ave, Marshalltown IA 50158 641-752-1585 Poweshiek GRMH/ Capstone Behavioral Healthcare, Inc 200 4 th Ave W, Grinnell IA 50112 641-236-2347 2521 University Blvd, Suite 121, Ames IA Story Eyerly Ball Community Mental Health Services 515-598-3300 50010 Warren Eyerly-Ball Community Mental Health Services 1301 Center St, Des Moines, IA 50139 515-243-5181 24 hour access to crisis response and evaluation: The Community Mental Health Centers (CMHC s) have trained mental health professionals available by phone 24 hours per day, as well as walk-ins during business hours. The primary goals of these agencies are crisis assessment, resolution, and screening for inpatient hospitalization. CICS provides an on-call stipend to providers to ensure service is available in each county. Crisis Evaluation: CICS initiated funding to the Mental Health Centers to assist with quicker access to crisis appointments. The crisis psychiatric grant was established in order to meet the identified need for psychiatric care on a crisis basis via additional crisis appointments. This service is available to all residents of CICS. CICS funds an administrative fee and guarantees payments for crisis appointments that are not filled and/or not billable through 3rd party payers. Walk-in Services: During normal business hours of operation. Walk-in services provide face-to-face screening and intervention on an unscheduled basis. Walk-in services are directed at achieving one or more of the following outcomes: immediate relief of distress in crisis situations, referral to or arrangement for additional mental health services or substance abuse services which may be needed, self-directed access to mental health services. Planning for FY 17 The focus of crisis planning in FY17 will be to develop service and supports to assist individuals at an earlier stage of crisis to avoid the need for more intensive services. Level of service needs in each member county has been established through gathering of information on providers and services in each area. Prevention, Education and Public Awareness Prevention begins with community education. CICS provides Mental Health First Aid (MHFA) training. Our initial focus has been on law enforcement, first responders, and schools. MHFA has proven an important tool for prevention and CICS will continue to offer MHFA training by certified trainers during FY 17. Additionally, CICS allocated funds to Mental Health Centers for community crisis response and public education. CICS also has contracted and is collaborating with NAMI of Central Iowa to expand public education and awareness and family and consumer support to all areas of the region. Fiscal Year 2017 6

Response Consultation Services: Consultation services to local hospitals, emergency personnel, and law enforcement are available. CICS financially supports access to tele-psychiatry at participating local hospital emergency rooms and county jails for this purpose though Evizzit- Integrated Telehealth Partners (ITP). ITP contracts directly with health care providers specializing in the provision of telehealth psychiatric services who are qualified to provide the clinical services required. The service is available on a 24-hour basis to each hospital. We ran into some delays with hospital credentialing so the availability was less than 24 hours initially. ITP will endeavor to make a psychiatric provider available to patients with a wait of no longer than two hours. ITP also provides access to appointmentbased psychiatric services to the inmates of each jail located within the region that contracts for service. Resolution Service Coordination: Providers of crisis services make referrals for coordination of services and needed follow-up with the region as appropriate. CICS has added service coordination staff to assist with follow-up. Individual Support Plans: Resolution of crises are handled through the normal services and supports people receive and are required elements in the treatment and support plans that are prepared by Network Providers, Integrated Health Homes, Targeted Case Management, and Service Coordination. Customized plans are developed to help an individual identify the triggers that lead to crisis and coping mechanisms or natural supports to help them relieve symptoms to avoid crisis situations. Some agencies also develop a Wellness Recovery Action Plan (WRAP) that complements the coordination plan. When these plans are developed, the goal is to figure out an environment and support structure that works for a person to mitigate the triggers that lead to crisis. The CICS Service Coordination unit provides intake, referral and eligibility functions and acts as the case worker for ongoing regionally funded cases. Additional Planning Crisis planning includes a continuum of services and supports in order to meet the diverse needs of individuals. We have categorized the services as emergent, urgent and routine in order to provide intervention at the earliest point. Emergent services include: Crisis Line, Early Access to screening in the local Emergency rooms, Inpatient with a need to determine placement options for those refused by Inpatient units, 23 Hour Observation, Residential Crisis Stabilization and Community Based Stabilization including mobile response. Urgent includes: Transition Homes, Crisis Psychiatric and Therapy appointments through local providers and Jail Diversion. Routine includes: Supported Community Living Services, Vocational services, Outpatient services, Family and Peer support, Service Coordination, Public Education and Transportation. Emergent: Crisis Line: Central Iowa Community Services contracts with Foundation 2 to provide a Crisis Line that serves the residents of the counties within the CICS region. Foundation 2 has the ability to geographically restrict the incoming toll free line to residents of the counties included in the region. The Crisis Line is available 24 hours a day and 7 days a week. The purpose is to achieve immediate relief of distress in pre crisis and crisis situations, reduction of the risk of escalation of a crisis, arrangements for emergency responses when necessary to protect individuals in a crisis, and referral of callers to appropriate services when other or additional intervention is required. Foundation 2 s counselors provide crisis counseling and/or linkage to resources in the CICS region as needed. Community resource information is provided to Foundation 2 for appropriate local referrals. CICS will continue contracting for the Central Iowa Crisis Line. We are also considering utilizing a warm line or peer run help line. Early Access to screening: CICS funds emergency telehealth psychiatric services in the emergency room for participating hospitals through a CICS contracted provider, Evizzit dba Integrated Telehealth Partners (ITP). ITP provides access to a provider of psychiatric services on a 24-hour basis. ITP contracts directly with health care providers specializing in the provision of telehealth psychiatric services who are qualified to provide the clinical services required. ITP will endeavor to make a psychiatric provider available to patients with a wait of no longer Fiscal Year 2017 7

than two hours. CICS is reviewing utilization of tele psychiatry at the local emergency rooms and gathering feedback to improve access to Crisis evaluations. Inpatient: In the FY 15 Annual Report CICS identified Inpatient services as a problem area in regards to access. We are not alone in our struggle with individuals needing inpatient treatment but are not able to secure placement within the access standard timeframe, even though beds are available. There is a statewide need to find solutions for individuals with complex needs. CICS will work with other regions, other funders and providers to address the issue including development of 23 hour observation alternatives. Residential Crisis Stabilization: CICS contracts with Mary Greeley Transitional Living Program (TLP) in Ames for crisis stabilization and hospital diversion. CICS also contracts with Hope Wellness Center to provide Residential Based Crisis Stabilization. The purpose of the Hope Wellness Center is to reduce the number of people who, during a mental health crisis, are involuntarily hospitalized, or inappropriately incarcerated. Individuals receive professional, short-term intervention and are linked to ongoing support, services and community resources. Mobile response: Eyerly Ball staff serves as a liaison for police and dispatch as follow up to mental health related calls. Staff assess individual needs, identify interventions, and refer for ongoing supports. Community Based Stabilization: CICS has earmarked funds to develop community based stabilization with local county providers. Urgent: Transition homes: A pilot project for transitional beds was initiated in 2016. Similar projects will be created in other areas of the region. The transition home provides services to individuals in the community that struggle with the ongoing management of their mental illness (i.e., follow doctor orders, taking/obtaining medications, attending scheduled therapy/psychiatric appointments, following parole/probation guidelines). Individuals receive services and supports while residing in the transition home. Stable and safe housing aids individuals in achieving identified goals and managing their ongoing mental health while decreasing the likelihood of hospitalization and/or legal involvement. The individuals residing in the transition home develop a 30, 60, 90 day transition plan with the goal of obtaining the necessary resources and supports to live independently in the community and/or are referred to a program that can continue to provide the level of services needed over an extended period of time. Crisis Psychiatric and Crisis Therapy appointments through local providers: CICS will continue to provide access to crisis psychiatric appointments and will add access to therapy appointments through the Community Mental Health Centers. Jail Diversion: CICS has made tele psych available to inmates located in the jails in the region at the discretion of local law enforcement. ITP provides appointment-based psychiatric services to the inmates of each jail located within the region that contracts for service. ITP facilitates services for the contracted hours upon a schedule arranged between the jail and available provider. Therapy services are also available through various providers. Intensive Case Management is available in Story and Jasper Counties and expansion to other areas is being planned. Jail Diversion services are a collaboration of regionally funded services and local planning efforts to fit the needs of the individual county. CICS has budgeted additional funds for law enforcement training in Mental Health First Aid, and Crisis training. Routine Services: Community Based Services: CICS allows for expansion of the service network as needs arise. Providers are encouraged to expand services to meet the needs of clients in all Community Based Services. FY 17 will mark the 3 rd year for the vocational services expansion RFP. CICS will be adding outcomes measures and methodology to encourage providers to focus on community based employment. Fiscal Year 2017 8

Outpatient Services: The need continues for development and expansion of outpatient services. We continue to work on increasing the provider network, and collaborating with providers on recruitment and retention of professional staff. We have earmarked funds for financial assistance through startup or other grant options. To address the statewide shortage of Psychiatric Services, CICS has turned to telemedicine to increase access to underserved areas. The use of Tele psychiatry will improve timely access and reduce hospital admissions. Family and Peer Support: Recovery services through peer and family support is an identified need. Recruitment of peers and family members to attend training opportunities is underway. CICS is also being assisted by NAMI of Central Iowa for Peer to Peer and Family to Family trainings, and developing local support groups. Service Coordination: CICS is increasing the FTE status for our Service Coordination Unit to meet identified needs in each community. Utilizing Service Coordinators allows us to manage services at a local level through use of a continuum of care. CICS Service Coordinators are trained in options counseling and other specialized training such as SSI/SSDI Outreach, Access and Recovery (SOAR). CICS has added two additional Service Coordination Specialists to assist with transitioning individuals in congregate care and transitional care settings into suitable community based services. Public Education: CICS will continue to offer Mental Health First Aid training to local communities. We are also offering other specialized training and educational opportunities provided by Community Mental Health Centers. CICS will be providing training in Evidence Based Practiced and Trauma Informed Care for providers of service in our area. Transportation: Although transportation is not identified as a core service, it has been identified as one of the major barriers to receiving services. We have added additional providers to our network and plan to utilize Central Iowa Juvenile Detention for transportation to crisis stabilization units. Scope of Services and Projection of Need The FY 17 budget was developed by the Finance team, based on utilization for the current year. The budget was reviewed by the CICS Finance Committee made up of appointed Governing Board members, appointed auditors and treasurers and the finance team. The final step of the budget process is approval by the CICS Governing Board. Utilization data from the Community Services Network and an inventory of available services and providers in the CICS communities is reviewed annually. Throughout the year CICS staff, the regional advisory board, and local stakeholders identified unmet needs and areas for service development. Additional information from state agencies, consumers, and providers is gathered through needs assessments and quality reviews, and analyzed to determine if there are gaps in services or if barriers exist due to service offered, adequate provider network, restrictions on eligibility, restrictions on availability, or location. CICS attempts to develop plans to meet the needs and allocate funds accordingly. As stated in Iowa Code 331.397 (2) Within funds available the region shall pay for such services for eligible persons when payment through the medical assistance program or another third party payment is not available unless the person is on a waiting list for such payment or it has been determined that the person does not meet the eligibility criteria for any such service. As the funder of non- services, CICS is filling the gap for funding for services and support for individuals who are ineligible for, prior to eligibility determination for and for services not covered. CICS assists individuals in applying for all funding available to them and will collaborate on individualized planning for services and supports incorporating all funding streams available through regional Service Coordinators. Fiscal Year 2017 9

In FY17, pooled funds will pay for all services claims. Administrative claims will be paid through locally held funds retained in the counties. The chart below identifies and defines specific services and projects funds needed, based on current utilization and available services. Additional funds are budgeted to improve service access and the development of additional services including crisis and justice involved services. Scope of Services/Projection of Funds Needed Other Funding Sources Domains and Services Treatment Projection of need Development & Expansion Cost and private insurance Assessment & evaluation The clinical review by a mental health professional of the current functioning of the individual using the service in regard to the individual s situation, needs, strengths, abilities, desires and goals to determine the appropriate level of care. $40,000 $60,000 Standardized assessment and private insurance Mental health outpatient therapy Includes medication prescribing and management, therapy. Access standards: emergency within 15 minutes of contact, urgent within one hour of contact or 24 hours of phone contact, routine within 4 weeks of request for appointment (within 45 miles). $80,000 $275,000 Expansion and private insurance Mental health inpatient therapy (private) MHI 24-hour settings that provide services to treat acute psychiatric conditions. Primary goal is to provide a comprehensive evaluation, rapidly stabilize symptoms, address health and safety needs and develop a comprehensive and appropriate discharge plan. Access within 24 hours and close proximity. $50,000 $350,000 Basic Crisis Response Personal emergency response system An electronic device connected to a 24-hour staffed system which allows the individual to access assistance in the event of an emergency. $6,000 and private insurance Crisis evaluation The process used with an individual to collect information related to the individual s history and needs, strengths, and abilities in order to determine appropriate services or referral during an acute episode. Access within 24 hours. $200,000 $300,000 Expansion 24 hour access to crisis response Outpatient (24 Hour Crisis Response Services)-short term individualized mental health services following a crisis screening or assessment, which are designed to restore the individual to prior functional level. $100,000 Fiscal Year 2017 10

Support for Community Living Annual Service and Budget Plan and private insurance Home health aide Unskilled medical services which provide direct personal care. This service may include assistance with activities of daily living, such as helping the recipient to bathe, get in and out of bed, care for hair and teeth, exercise, and take medications specifically ordered by the physician. $60,000 Respite A temporary period of relief and support for individuals and their families provided in a variety of settings. The intent is to provide a safe environment with staff assistance for individuals who lack an adequate support system to address current issues related to a disability. Respite may be provided for a defined period of time; respite is either planned or provided in response to a crisis. $10,000 Home & vehicle modifications A service that provides physical modifications to the home or vehicle that directly address the medical health or remedial needs of the individual that are necessary to provide for the health, welfare, and safety of the member and to increase or maintain independence. - Supported community living Services provided in a non-institutional setting to adult persons with mental illness, intellectual, or developmental disabilities to meet the persons daily living needs Access standard within 4 weeks of request. $1,350,000 Voc Rehab Support for Employment Prevocational services Prevocational services- services that focus on developing generalized skills that prepare an individual for paid or unpaid employment. Skill development includes but is not limited to following directions, attending to tasks, task completion, problem solving, and safety and mobility training. Prevocational services can be provided in a variety of settings. $275,000 Day habilitation Services that assist or support the individual in developing or maintaining life skills and community integration. Services shall enable or enhance the individual s functioning, physical and emotional health and development, language and communication development, cognitive functioning, socialization and community integration, functional skill development, behavior management, responsibility and self-direction, daily living activities, self-advocacy skills, or mobility. Voc Rehab Voc Rehab Job development Supported employment An approach to helping individuals participate as much as possible in competitive work in integrated work settings that are consistent with the strengths, resources, priorities, concerns, abilities, capabilities, interests, and informed choice of the individuals. Services are targeted for individuals with significant disabilities for whom competitive employment has not traditionally occurred; or for whom competitive employment has been interrupted or intermittent as a result of a significant disability including either individual or group supported employment, or both, consistent with evidence-based practice standards published by the Substance Abuse and Mental Health Services Administration. Access standards within 60 days of request. $250,000 $450,000 $750,000 Supported Employment grant Group Supported employmentenclave Group Supported Employment - the job and training activities in business and industry settings for groups of no more than eight workers with disabilities. Group settings include enclaves, mobile crews, and other business based workgroups employing small groups of workers with disabilities in integrated, sustained, paid employment. $16,000 Recovery Services Family support Family support peer specialist and peer support specialist that assist the family of an individual to live successfully including, but not limited to, education and information, individual advocacy, family support groups, and crisis $30,000 $30,000 Training and enhancement response. Peer support $20,000 $40,000 Training and development Fiscal Year 2017 11

Service Coordination Annual Service and Budget Plan Case management Health homes Service provided by a case manager, service coordinator or Health Home through an interdisciplinary array of medical care, behavioral health care, and community-based social services and supports. Assists individuals in gaining access to needed medical, social, educational, and other services through assessment, development of a care plan, referral, monitoring and follow-up using a strengths-based service approach that helps individuals achieve specific desired outcomes leading to a healthy self-reliance and interdependence with their community. Access within 10 days of request. $10,000 Core Evidenced Based Treatment Social Services Block Grant Education & Training Services - provider competency Educational and Training Services means training related to provider competency in delivering co-occurring integrated services, trauma-informed services and evidenced-based practices. $100,000 Supported housing Supportive housing means a combination of housing and services intended as a cost-effective way to help people live more stable, productive lives; tenancy not predicted on services. $125,000 Assertive community treatment (ACT) An intensive and highly integrated approach for community mental health service delivery. ACT programs serve outpatients whose symptoms of mental illness result in serious functioning difficulties in several major areas of life, often including work, social relationships, residential independence, money management, and physical health and wellness. $125,000 Family psychoeducation Mandated Services Family psychoeducation- services including the provision of emotional support, education, resources during periods of crisis, and problem-solving skills consistent with evidence-based practice standards published by the Substance Abuse and Mental Health Services Administration. $60,000 State Oakdale Hospital Services provided at Iowa Medical & Classification Center Code of Iowa Chapter 812 $200,000 Commitment related (except 301) Mental health advocate Diagnostic Evaluations/Sherriff transportation/ Legal representation $591,000 $250,000 Fiscal Year 2017 12

Additional Core Domains Annual Service and Budget Plan Comprehensive Facility & Community Based Crisis Services 24 hour crisis line Warm line Crisis Hotline (fee paid to vendor) (24 Hour Crisis Line) Telephone crisis service- program that operates a crisis hotline either directly or through a contract. The service shall be available 24 hours a day and seven days a week including, but not limited to, relief of distress in pre-crisis and crisis situations, reduction of the risk of escalation, arrangements for emergency on-site responses when necessary, and referral of callers to appropriate services. Social Support (Warm Line) A line staffed by peer counselors, who provide nonjudgmental, nondirective support to an individual who is experiencing a personal crisis. $150,000 $50,000 $- $100,000 Mobile response A mental health services which provides on-site, face-to-face mental health crisis services for individuals experiencing a mental health crisis. Mobile crisis staff have the capacity to intervene, wherever the crisis is occurring, including but not limited to the individual s place of residence, emergency rooms, police stations, outpatient mental health settings, schools, recovery centers or any other location where the individual lives, works, attends school or socializes. $100,000 $ 650,000 Development in rural areas and private insurance 23 hour crisis observation & holding A level of care provided up to 23 hours in a secure and protected, medically staffed, psychiatrically supervised treatment environment. $- $500,000 Development Crisis Stabilization communitybased services Services provided in community-based settings to de-escalate and stabilize an individual following a mental health crisis. $100,000 $400,000 Development Crisis Stabilization residential services Services provided in short-term non community-based residential settings to de-escalate and stabilize a mental health crisis. $500,000 $250,000 Expansion Sub-Acute Services Subacute services-1-5 beds Subacute services-6 and over beds Partial Hospitalization (Sub Acute Services) A comprehensive set of wraparound services for persons who have had or are at imminent risk of having acute or crisis mental health symptoms that do not permit the persons to remain in or threatens removal of the persons from their home and community, but who have been determined by a mental heal professional and a licensed health care professional and a licensed health care professional, subject to the professional s scope of practice, not to need inpatient acute hospital services. $ - $ - Fiscal Year 2017 13

Justice System-Involved Services Annual Service and Budget Plan Mental health services in jails Coordination services Crisis prevention training Outpatient mental health services provided to individuals in criminal justice settings. Justice System Involved Coordination- service coordination provided to individuals in justice system. Educational and Training Services Safety training for law enforcement, first responders, etc., regarding mental health awareness such as Crisis Intervention Training (CIT). $150,000 $100,000 Expansion into all counties $75,000 $125,000 Expansion into all counties $100,000 Mental health court related costs Legal & Court-Related Services (Mental Health Court related expenses). $20,000 Develop through partnerships Additional Core Evidenced Based Treatment Psychiatric rehabilitation (IPR) Psychiatric Rehabilitation - is for individualized services designed to increase the consumer s ability to function independently to prevent or reduce the need for services in a hospital or residential setting, and to promote the consumer s recovery of the ability to perform a valued role in society. $50,000 Peer self-help drop-in centers Other Informational Services Social Support services- drop in centers and Clubhouse centers. $75,000 $75,000 Expansion Information & referral Public education Information & Referral are activities designed to provide facts about resources available/help to access those resources. Public Education Services - activities provided to increase awareness and understanding of the causes and nature of conditions or situations which affect a person's functioning in society. Focus on the following prevention activities, which are designed to convey information about the cause of conditions, situations, or problems that interfere with a person's functioning or prevent their occurrence or reduce their effect. And the abilities and contributions to society of all people; the causes and nature of conditions or situations which interfere with a person's ability to function; and the benefits that providing services and supports have for the community and for the individual. $50,000 $75,000 Fiscal Year 2017 14

Other Community Living Support Services Annual Service and Budget Plan Services management Services Management - is designed to help individuals and families identify service needs and coordinate service delivery but which do not constitute case management. $1,275,000 Service Coordinators available in each county Transportation Transportation is for services for consumers to conduct business errands or essential shopping, to receive medical services not reimbursed through Title XIX, to go to and from work, recreation, education or day programs, and to reduce social isolation. Guardian/conservator Guardian/Conservator - is activities provided as required by the court system to handle the personal business of the individual. Community Resources Representative payee Activities provided to manage an individual s finances. $35,000 Rent payments (time limited) Rent payment to avoid homelessness. $70,000 $175,000 $175,000 transport to crisis stabilization $20,000 Community Resources Other basic needs Other costs associated with basic necessities. $50,000 and private insurance Physiological outpatient treatment Activities designed to prevent, halt, control, relieve or reverse symptoms or conditions which interfere with the normal physiological functioning of the human body. $25,000 and private insurance Prescription meds Prescription medication, including medication prescribed for psychiatric conditions. $27,500 Transitional living program Transitional living means any type of living situation that is transition with the primary purpose or mission to help the individual become a productive member of society; length of stay may vary but is not permanent housing. $150,000 $600,000 Expand Similar projects Community support programs Vocational skills training Other Congregate Services Work services (work activity/sheltered work) RCF 6 and over beds Community Support Programs - is for comprehensive programs to meet individual treatment and support needs of consumers which enable consumers with a mental illness, intellectual disability, or a developmental 20 disability to live and work in a community setting. Training for specific skills related to specific job or position and/or customized employment. Sheltered Workshop Services - is for services provided by a facility carrying out a recognized program of rehabilitation, habilitation, or education for persons with disabilities, designed to lead to competitive employment. Residential care refers to long-term care given to adults or children who stay in a residential setting rather than in their own home or family home. Projection of need based on current services and funding $75,000 $15,000 $70,000 $1,350,000 $9,210,500 Funds allocated for expansion of services $4,800,000 Fiscal Year 2017 15

Expenditure Budget Below is the complete CICS Fiscal Year 2017 budget by Chart of Account code and separated by diagnostic code. Budget by Service Definition and Population Groups Mental Illness (40) FY 2017 Budget CENTRAL IOWA COMMUNITY SERVICES Intellectual Disability (42) Developmental Disability (43) Admin (44) Total Core Domains Treatment 43301 Assessment & evaluation 42305 Mental health outpatient therapy 71319 Mental health inpatient therapy-mhi 73319 Mental health inpatient therapy $ 50,000 $ 50,000 $ 100,000 $ 350,000 $ 5,000 $ 355,000 $ 350,000 $ 350,000 $ 50,000 $ 50,000 Basic Crisis Response 32322 Personal emergency response system $ 5,000 $ 1,000 $ 6,000 44301 Crisis evaluation $ 500,000 $ 500,000 44305 24 hour access to crisis response $ 100,000 $ 100,000 Support for Community Living 32320 Home health aide $ 50,000 $ 10,000 $ 60,000 32325 Respite $ 10,000 $ 10,000 32328 Home & vehicle modifications 32329 Supported community living $ - $ 1,000,000 $ 200,000 $ 150,000 $1,350,000 Fiscal Year 2017 16

50362 Prevocational services Support for Employment Annual Service and Budget Plan $ 75,000 $ 100,000 $ 100,000 $ 275,000 50367 Day habilitation $ 150,000 $ 50,000 $ 50,000 $ 250,000 50364 Job development 50368 Supported employment 50369 Group Supported employmentenclave $ 500,000 $ 400,000 $ 300,000 $1,200,000 $ 5,000 $ 5,000 $ 6,000 $ 16,000 Recovery Services 45323 Family support $ 50,000 $ 5,000 $ 5,000 $ 60,000 45366 Peer support $ 50,000 $ 5,000 $ 5,000 $ 60,000 21375 Case management Service Coordination $ 5,000 $ 5,000 $ 10,000 24376 Health homes $ - 04422 Education & Training Services - provider competency Core Evidenced Based Treatment $ 100,000 $ 100,000 32396 Supported housing 42398 Assertive community treatment (ACT) 45373 Family psychoeducation $ 125,000 $ 125,000 $ 125,000 $ 125,000 $ 50,000 $ 5,000 $ 5,000 $ 60,000 Core Domains Total $3,690,000 $ 850,000 $622,000 $5,162,000 Fiscal Year 2017 17

Mandated Services Annual Service and Budget Plan 46319 Oakdale $ 200,000 $ 200,000 74XXX 75XXX Commitment related (except 301) Mental health advocate $ 580,000 $ 6,000 $ 5,000 $ 591,000 $ 250,000 $ 250,000 Mandated Services Total Additional Core Domains 44346 24 hour crisis line $1,030,000 $ 6,000 $ 5,000 $ 1,041,000 Comprehensive Facility & Community Based Crisis Services $ 200,000 $ 200,000 44366 Warm line $ 100,000 $ 100,000 44307 Mobile response 44302 23 hour crisis observation & holding 44312 Crisis Stabilization communitybased services 44313 Crisis Stabilization residential services $ 750,000 $ 750,000 $ 500,000 $ 500,000 $ 500,000 $ 500,000 $ 750,000 $ 750,000 Sub-Acute Services 63309 Subacute services-1-5 beds 64309 Subacute services-6 and over beds $ - $ - Fiscal Year 2017 18

Justice System-Involved Services Annual Service and Budget Plan 46305 Mental health services in jails $ 250,000 $ 250,000 25xxx Coordination services $ 200,000 $ 200,000 46422 Crisis prevention training 46425 Mental health court related costs 74301 Civil commitment prescreening evaluation $ 100,000 $ 100,000 $ 20,000 $ 20,000 $ - Additional Core Evidenced Based Treatment 42397 Psychiatric rehabilitation (IPR) 42366 Peer self-help drop-in centers $ 50,000 $ 50,000 $ 150,000 $ 150,000 Additional Core Domains Total Other Informational Services $3,570,000 $ $ $ 3,570,000 03XXX Information & referral $ 50,000 $ 50,000 04XXX Consultation (except 422) $ - 05XXX Public education $ 75,000 $ 75,000 Other Informational Services Total $ 125,000 $ - $ - $ 125,000 Fiscal Year 2017 19

Other Community Living Support Services Annual Service and Budget Plan 22XXX Services management $ 425,000 $ 425,000 $ 425,000 $ 1,275,000 31XXX Transportation $ 250,000 $ 50,000 $ 50,000 $ 350,000 32326 Guardian/conservator $ 5,000 $ 10,000 $ 5,000 $ 20,000 32327 Representative payee $ 20,000 $ 10,000 $ 5,000 $ 35,000 33340 Rent payments (time limited) $ 50,000 $ 10,000 $ 10,000 $ 70,000 33399 Other basic needs $ 50,000 $ 50,000 41305 Physiological outpatient treatment $ 25,000 $ 25,000 41306 Prescription meds $ 20,000 $ 2,500 $ 5,000 $ 27,500 42310 Transitional living program $ 750,000 $ 750,000 42396 Community support programs 45399 Other family & peer support $ 75,000 $ 75,000 $ - 50361 Vocational skills training $ 5,000 $ 10,000 $ 15,000 Other Community Living Support Services Total Other Congregate Services 50360 Work services (work activity/sheltered work) $1,675,000 $ 507,500 $ 510,000 $2,692,500 $ 10,000 $ 50,000 $ 10,000 $ 70,000 64XXX RCF 6 and over beds $1,175,000 $ 125,000 $ 50,000 $ 1,350,000 Other Congregate Services Total $1,185,000 $ 175,000 $ 60,000 $ 1,420,000 Administration 11XXX Direct Administration $ 1,400,500 $ 1,400,500 12XXX Purchased Administration $ 265,500 $ 265,500 Administration Total $ 1,666,000 $ 1,666,000 Regional Totals $11,275,000 $ 1,538,500 $ 1,197,000 $ 1,666,000 $ 15,676,500 Fiscal Year 2017 20

Revenues CICS does not anticipate funds from the state. CICS will rely on fund balance and local levies to meet the service needs for non- services for FY 17. CICS Governing Board equalized the levies for the 10 counties. FY16 ESTIMATED FUND BALANCE $ 17,382,624 FY 17 LEVY RECOMMENDATION $ 7,307,507 TOTAL FUNDS FOR FY 17 $ 24,609,131 FY 17 EXPENDITURE BUDGET $ 15,676,500 FY 17 ESTIMATED FUND BALANCE $ 9,013631 Financial Forecasting Historical service utilization is the starting point for all financial projections. Changes in the system provide challenges in using historic data to project expenditures. Fiscal Year 2016 was the first year CICS used a combined regional budget and that will provide a base for further analysis of expenditure trends. FY 17 will continue with services funded through the fiscal agent account. This allows for standardization of the Chart of Account codes and more consistent reporting. We also have merged county data that has allowed us to estimate utilization and system growth. The loss of transition funds resulted in a decrease of available revenue and created a disparity in the per capita contribution of each county. However, CICS counties had substantial fund balances coming into the region. For FY17 the Governing Board equalized the per capita, with plans to use the region s fund balance to fund a portion of the annual costs and to reduce the fund balance to the required level. The per capita amount should remain relatively stable for the next couple of years. The implementation of additional community based and crisis services will increase our expenditures in some service domains, but will be partially offset by the decrease in congregate care settings. CICS approaches the budget conservatively, estimating revenues while allowing for expenditures for a number of expansion opportunities that are in the planning phase. Provider Reimbursement Provisions CICS will contract with MHDS providers, and non-traditional providers whose base of operation is in the region. CICS will also honor contracts that other regions have negotiated with their local providers. Incorporating the System of Care Approach in Requests for Proposals and Contracts: In order to support service expansion efforts, CICS may offer requests for proposals (RFPs) in combination with other strategies, including traditional fee for service, startup costs, and grant funds for specified services. CICS provides funding by incorporating all available funding, including insurance resources, in the system of care. Request for Proposal: CICS may issue a competitive request for proposal to expand services as needs are identified. Fee for service: Fiscal Year 2017 21

Contractual requirements will be used to ensure that all system participants are aligned with system of care principles. Service providers shall provide monthly billing invoices within 60 days of service provision, and other information requested of the provider for utilization review. The monthly billings shall include the following information: Name and unique identifier of each individual served during the reporting period. Dates of service. Number of units of service delivered to each individual served. When requested, attendance records. Unit rate and total cost of the units provided to each individual. Copayments or other charges billed to other sources shown as deductions on the billing. Actual amount to be charged to the Region for each individual for the period. Grant funds: CICS may utilize block grant payments when a service does not fit the traditional fee for service method of payment and may be considered to cover costs of new services until a fee for service rate can be established. Other uses may be to provide access to crisis services. CICS is beginning to incorporate outcomes into the provider contracts by collaborating with other regions. A performance payment structure is in development to be implemented in the future. In order to be successful, value based or performance payments must be coordinated with multiple payers in order for the financial incentives to be large enough to create change. CICS looks forward to working with all payment sources to achieve this initiative. All eligible bills shall be paid within 60 days of receipt of required documentation unless unforeseen circumstances exist. Fiscal Year 2017 22

Provider Network CICS requires providers to meet all applicable licensure, accreditation and certification standards. Annual Service and Budget Plan CICS has identified the following providers currently contracting with the region. Additional providers including non-traditional providers may be added throughout the year as services are developed to meet the continuum of service needs of individuals. Provider Access, Inc. PO Box 268 Hampton 50441 Ames Counseling/Psyc Services 3600 W. Lincoln Way Ste. 4 Ames 50014 Anne McCrea 600 5th. Street Ste. 200 Ames 50010 Arc of Story County 130 S. Sheldon Ave. Ste. 302 Ames 50010 Berryhill Center 704 Kenyon Road Ft. Dodge 50501 Boone County Transportation 328 Snedden Drive Boone 50036 Capstone Behavioral Healthcare 306 N. 3rd Ave. E. Newton 50208 Center Associates 9 North 4th Ave. Marshalltown 50158 Central Iowa CM 126 S Kellogg Ste 001 Ames 50010 Central Iowa Juvenile Detention Ctr 2317 Rick Collins Way Eldora 50627 Central Iowa Psychological Services 223 S. Walnut Ave. Ames 50010 Christian Opportunity Center 1602 North 14th St. Indianola 50125 Central Iowa Recovery 500 Fairmeadow Dr. Webster City 50595 CIRSI 111 E. Linn St. Marshalltown 50158 Consumer Credit Counseling Services 1003 W 4th St Waterloo 50702 County Community Services CM 900 W 3rd Boone 50036 Crossroads Behavioral Health Services 1003 Cottonwood Rd. Creston 50801 Diamond Life 4912 Barnes City Rd. Montezuma 50171 Eyerly Ball CMHS 1301 Center St. Des Moines 50309 Foundation 2 1714 Johnson Ave NW Cedar Rapids 52405 Franklin County Home Care 1600 Central Ave E Hampton 50441 Friends Forever 500 Fairmeadow Dr. Webster City 50595 Friendship Ark, Inc. 130 S Sheldon Ave Ste 203 Ames 50014 Friendship Club 1201 14th Ave. Eldora 50627 Genesis Development 401 W. McKinley PO Box 438 Jefferson 50129 Grinnell Regional Medical Center 210 4th Ave. Grinnell 50112 Hansen Family Hospital Behavioral Health 322 1/2 College Ave Iowa Falls 50126 HIRTA 2840 104th St. Urbandale 50322 Home Instead Senior Care House of Mercy 200 N. 8th Ave. E. Newton 50208 Integrated Telehealth Partners (Evizzit) 2829 Westown Pkwy Ste 220 W.DesMoines 50266 Integrated Treatment Services 303 S 2nd Ave W Newton 50208 Jasper Co. Board of Health 115 N. 2nd Ave. E. Ste. C Newton 50208 Fiscal Year 2017 23